Provider Demographics
NPI:1659585354
Name:BOULEVARD MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:BOULEVARD MEDICAL CENTER INC.
Other - Org Name:BOULEVARD MEDICAL CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:FLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BS MPA
Authorized Official - Phone:757-460-3330
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-3330
Mailing Address - Fax:757-460-3781
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-460-3330
Practice Address - Fax:757-460-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty